António P. Ribeiro

Tracking novelties in psychotherapy process research: The innovative moments coding system

Abstract This article presents a method for the assessment of innovative moments, which are novelties that emerge in contrast to a clients problematic self-narrative as expressed in therapy, the innovative moments coding system (IMCS). The authors discuss the theoretical background of the IMCS as well as its coding procedures. Results from several studies suggest that the IMCS is a reliable and valid coding system that can be applied to several modalities of psychotherapy. Finally, future research implications are discussed.

Narrative change in emotion-focused therapy: How is change constructed through the lens of the innovative moments coding system?

Abstract The aim of this study was to advance understanding of how clients construct their own process of change in effective therapy sessions. Toward this end, the authors applied a narrative methodological tool for the study of the change process in emotion-focused therapy (EFT), replicating a previous study done with narrative therapy (NT). The Innovative Moments Coding System (IMCS) was applied to three good-outcome and three poor-outcome cases in EFT for depression to track the innovative moments (IMs), or exceptions to the problematic self-narrative, in the therapeutic conversation. IMCS allows tracking of five types of IMs events: action, reflection, protest, reconceptualization, and performing change. The analysis revealed significant differences between the good-outcome and poor-outcome groups regarding reconceptualization and performing change IMs, replicating the findings from a previous study. Reconceptualization and performing change IMs seem to be vital in the change process.

Innovative Moments and Change in Emotion-Focused Therapy: The Case of Lisa

This article presents an intensive analysis of a good-outcome case of emotion-focused therapy—the case of Lisa—using the Innovative Moments Coding System (IMCS). IMCS, influenced by narrative therapy, conceptualizes narrative change as resulting from the elaboration and expansion of narrative exceptions or unique outcomes to a clients core problematic self-narrative. IMCS identifies and tracks the occurrence of five different types of narrative change: action, reflection, protest, reconceptualization, and performing change. This is the first attempt to use the IMCS with cases outside the narrative tradition. We discuss the results, emphasizing the commonalities and major differences between this case and other good-outcome cases.

How collaboration in therapy becomes therapeutic: The therapeutic collaboration coding system

BACKGROUND The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in therapy. AIM We propose a conceptual account of how collaboration in therapy becomes therapeutic. In addition, we report on the construction of a coding system - the therapeutic collaboration coding system (TCCS) - designed to analyse and track on a moment-by-moment basis the interaction between therapist and client. Preliminary evidence is presented regarding the coding systems psychometric properties. The TCCS evaluates each speaking turn and assesses whether and how therapists are working within the clients therapeutic zone of proximal development, defined as the space between the clients actual therapeutic developmental level and their potential developmental level that can be reached in collaboration with the therapist. METHOD We applied the TCCS to five cases: a good and a poor outcome case of narrative therapy, a good and a poor outcome case of cognitive-behavioural therapy, and a dropout case of narrative therapy. CONCLUSION The TCCS offers markers that may help researchers better understand the therapeutic collaboration on a moment-to-moment basis and may help therapists better regulate the relationship.

The role of mutual in-feeding in maintaining problematic self-narratives: Exploring one path to therapeutic failure

Abstract According to the authors narrative model of change, clients may maintain a problematic self-stability across therapy, leading to therapeutic failure, by a mutual in-feeding process, which involves a cyclical movement between two opposing parts of the self. During innovative moments (IMs) in the therapy dialogue, clients’ dominant self-narrative is interrupted by exceptions to that self-narrative, but subsequently the dominant self-narrative returns. The authors identified return-to-the-problem markers (RPMs), which are empirical indicators of the mutual in-feeding process, in passages containing IMs in 10 cases of narrative therapy (five good-outcome cases and five poor-outcome cases) with females who were victims of intimate violence. The poor-outcome group had a significantly higher percentage of IMs with RPMs than the good-outcome group. The results suggest that therapeutic failures may reflect a systematic return to a dominant self-narrative after the emergence of novelties (IMs).

A dynamic look at narrative change in psychotherapy: A case study tracking innovative moments and protonarratives using state space grids

Abstract This study aims to further the understanding of how innovative moments (IMs), which are exceptions to a clients problematic self-narrative in the therapy dialogue, progress to the construction of a new self-narrative, leading to successful psychotherapy. The authors’ research strategy involved tracking IMs, and the themes expressed therein (or protonarratives), and analysing the dynamic relation between IMs and protonarratives within and across sessions using state space grids in a good-outcome case of constructivist psychotherapy. The concept of protonarrative helped explain how IMs transform a problematic self-narrative into a new, more flexible, self-narrative. The increased flexibility of the new self-narrative was manifested as an increase in the diversity of IM types and of protonarratives. Results suggest that new self-narratives may develop through the elaboration of protonarratives present in IMs, yielding an organizing framework that is more flexible than the problematic self-narrative.

Therapeutic collaboration and resistance: Describing the nature and quality of the therapeutic relationship within ambivalence events using the Therapeutic Collaboration Coding System

Abstract Objectives: We understand ambivalence as a cyclical movement between two opposing parts of the self. The emergence of a novel part produces an innovative moment, challenging the current maladaptive self-narrative. However, the novel part is subsequently attenuated by a return to the maladaptive self-narrative. This study focused on the analysis of the therapeutic collaboration in episodes in which a relatively poor-outcome client in narrative therapy expressed ambivalence. Method: For our analysis we used the Therapeutic Collaboration Coding System, developed to assess whether and how the therapeutic dyad is working within the therapeutic zone of proximal development (TZPD). Results: Results showed that when the therapist challenged the client after the emergence of ambivalence, the client tended to invalidate (reject or ignore) the therapists intervention. Conclusions: This suggests that in such ambivalence episodes the therapist did not match the clients developmental level, and by working outside the TZPD unintentionally contributed to the maintaining the clients ambivalence.

Narrative processes of innovation and stability within the dialogical self

In dialogical self theory (DST), the way dialogical relations allow innovation and transformation of the previous dialogical patterns is of central importance (Hermans 2004). In this chapter we explore a dialogical process through which innovation is aborted in psychotherapy – a cyclical movement between two opposing voices, one dominant that organizes the client’s problematic self-narrative, and one innovative, non-dominant voice. We also discuss two different paths of escaping this cyclical movement. In the first path the innovative voice gains power over the previously dominant one, while in the second path the two opposing voices engage in dialogue, transforming them. These processes will be illustrated with two different cases from psychotherapy. Finally, we analyse the implications of our findings by DST.

Narrative change in emotion-focused psychotherapy : a study on the evolution of reflection and protest innovative moments

Abstract Innovative moments (IMs) are exceptions to a clients problematic self-narrative in the therapeutic dialogue. The innovative moments coding system is a tool which tracks five different types of IMs—action, reflection, protest, reconceptualization and performing change. An in-depth qualitative analysis of six therapeutic cases of emotion-focused therapy (EFT) investigated the role of two of the most common IMs—reflection and protest—in both good and poor outcome cases. Through this analysis two subtypes (I and II) of reflection and protest IMs were identified, revealing different evolution patterns. Subtype II of both reflection and protest IMs is significantly higher in the good outcome group, while subtype I of both IMs types does not present statistically significant differences between groups. The evolution from subtype I to subtype II across the therapeutic process seems to reflect a relevant developmental progression in the change process.

Maintenance and Transformation of Problematic Self-Narratives: A Semiotic-Dialogical Approach

This study focuses on how the emergence of innovative moments (IMs), which are exceptions to a person’s dominant self-narrative (i.e., his or her usual way of understanding and experiencing), progresses to the construction of a new self-narrative. IMs challenge a person’s current framework of understanding and experiencing, generating uncertainty. When uncertainty is excessively threatening, a semiotic strategy to deal with it often emerges: attenuation of novelty’s meanings and implications by a quick return to the dominant self-narrative. From a dialogical perspective, a dominant voice (which organizes one’s current self-narrative) and a non-dominant or innovative voice (expressed during IMs) establish a cyclical relation, mutual in-feeding, blocking self-development. In this article, we analyze a successful psychotherapeutic case focusing on how the relation between dominant and non-dominant voices evolves from mutual in-feeding to other forms of dialogical relation. We have identified two processes: (1) escalation of the innovative voice(s) thereby inhibiting the dominant voice and (2) dominant and innovative voices negotiating and engaging in joint action.